Laguna Beach Water Polo - Online Registration

Welcome to Laguna Beach Water Polo!

PLAYER INFO
Please complete the member registration form below with player name, sex, birth date, and school.

PARENT INFO
When you reach the fields for cell phone, texting cell and email, please type your family's primary contact info for important club announcements and alerts; this would normally be the phone/email for the parent/guardian. If you wish to provide additional phone/email for the player, please click the options to "add another".

USA WATER POLO
In order to complete the club member registration process, each athlete must be a Gold member of USA Water Polo. If you are not yet a USA Water Polo member, please visit USA Water Polo to register your player as a Gold Membership, then return to this page with the membership number and expiration date necessary to complete this form.

* Starred fields are required

First Name *

Preferred (Nickname)

Middle Name

Last Name *

Create Password

Sex *

Female Male

Birth Date *

School *

Cell Phone *

Texting Cell

Mobile provider

Email *

Country *

Street *

Street 2

City *

State *

ZIP Code *

USWP Number *

Exp. Date

(12/31/yyyy) USA Water Polo information/Sign-up

Left/Right-handed?

Left Right Both

Parent/Guardian *

Emergency Contact

Name *

Relation

Phone *

Name 2 *

Relation 2

Phone 2 *